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On the contrary, the most specific strategy prompted 447 less colonoscopies compared to the reference strategy, but missed 13 cancers and 116 advanced adenomas.
Positivity rate was 4.5% for reference strategy and 8.0 and 2.0% for the most sensitive and the most specific strategy, respectively.
As expected the most specific strategy (algorithm 4) identified less prevalent cases than the most sensitive one (algorithm 2); however, 9 69.2%) prevalent cases were found in GD, 78 (82.1%) in BD, 14 66.7%) in MD and 36 81.8%) in ZD.
Identifying the optimal strategy was not the aim of this study; however, although based on a limited sample size, our data suggest that minimising PR (by adopting the most specific strategy) is associated to a substantial loss in the DR, whereas, on the other hand, maximising the DR (by adopting the most sensitive strategy) is associated to hardly acceptable recall rate.
Colonoscopies needed to detect one cancer (i.e., the inverse of PPV) range from 21.2 with the less specific to 8.6 with the most specific strategy, whereas corresponding figures to detect one significant neoplasia (cancer+advanced adenoma) are between 2.7 and 1.5, respectively (see Table 5).
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The most specific strategies, on the contrary, determined a statistically significant increase of PPV for significant neoplasia ranging from 12.6 to 20%, as the positivity threshold increased.
The number needed to scope to find a cancer or an advanced adenoma was lower than 2 (1.5 1.7) for the most specific strategies, whereas it was 2.4 2.7, according to different thresholds, for the most sensitive ones.
This needs to be accompanied by increasing public awareness about the schemes and developing innovative enrolment strategies to reach out to the poorest and most vulnerable; specific strategies and examples for intervention packages are outlined in individual papers [ 17- 22, 28].
The performance of alternative strategies was measured using the incremental cost-effectiveness ratio, which is defined as the additional cost of a specific strategy, divided by its additional benefit compared with the next-most-expensive strategy.
Sumner Paine had a more specific strategy.
The most important thing is being able to pass my knowledge on to others and allowing them to flourish as individuals and as part of a team with a specific strategy.
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Justyna Jupowicz-Kozak
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